DoH guidance on 'improving GP access and responsiveness' advises trusts to segment practices by their performance and potential to improve, and 'tailor support accordingly'.
The system would mean that practices that perform well but show a 'lack of interest' in improving would be given a 'wake up call' to do more.
Practices that are both high performers and 'keen improvers', meanwhile, would be 'publicly celebrated'.
But those that do badly on both would be subject to 'tight performance management'.
The document warns: 'Should an occasion arise where expected improvements are not achieved, the PCT will need to consider the contractual levers available.' This would include remedial or breach notices.
The guidance sets out a range of ways for PCTs to improve practices' access performance.
It says that improvements could be motivated by poor absolute performance, or by 'significant variation in the patch'.
PCTs could improve access by ensuring minimum standards and analysing data from practice IT systems, it adds.
PCTs are advised to publish data ranking practice performance, to drive improvement.
They are also encouraged to survey patients to ensure practices meet their needs. 'If a PCT was to learn through engagement that a high proportion of its patients were employed during core hours and preferred telephone consultations,' it says, 'this could impact the offering of practices.'
The guidance also proposes that practices 'start an hour earlier for a week in order to create extra capacity'.
But it admits that many of the measures it proposes may encounter 'some resistance'. 'Change is never comfortable,' it says, 'and this change may feel unprecedented to GPs.'